1. Field of the Invention
The invention relates generally to the field of endotracheal intubation, and more particularly, to an endotracheal tube retractor useful in the intubation of patients under either direct vision or blind techniques.
2. Description of the Prior Art
The intubation of patients is a technique well known in the anesthesia and medical arts, and involves the insertion of an endotracheal tube into the trachea through either the nose or mouth. In the direct technique, the tip of the endotracheal tube is observed with a laryngoscope as the tube progresses down the posterior pharynx into the glottis, through the vocal cords and into the trachea. During nasotracheal intubation, it is often necessary to guide the endotracheal tube into the glottis with the aid of forceps. In intubation of this type, the visible end of the endotracheal tube is grasped with the forceps, and the practioner controls the direction of the tip of the tube in order to glide it into the glottis and through the vocal cords.
In the blind technique, the tube direction is changed by flexion, extension, or rotation of the head, as the blind application of forceps is extremely hazardous and is of very limited value in facilitating blind intubation.
U.S. Pat. No. 3,701,348 to Navara discloses a tool used for pathological procedures, such as the opening of the skull. To this end, the device of Navara is provided with a relatively flat elongated center portion, a flat chiseled portion formed on one end of the center portion, and a curved retractor portion formed on the other end of the central portion. As seen in FIG. 1 of the patent, the retractor portion 17 comprises an inwardly curved member and is of about the same length as the chisel portion 15. In use, a cut is made in the skull by a suitable high velocity saw. The chiseled portion 15 is inserted into the groove made by the saw blade, and is then laterally moved to separate the parts of the skull by prying. The retractor portion 17 is then used to hook an edge of the severed portion, and to remove the same. However, while the device disclosed by Navara may have certain utility as a skull retractor, it is much larger than anything which would be usable for tracheal work. Furthermore, the center portion of the Navara device is flat, and is therefore unsuitable for gripping by the hand of a practitioner where delicate work is involved.
The V. Mueller & Co. Catalogue (1929) at page 232 discloses two types of retractors for use in tracheal work. The retractor A8535, known as Shurly's retractor, consists merely of a flat length of sheet steel with a bend in one end. This type of retractor has distinct disadvantages in that the central gripping portion thereof is wide and flat and is therefore difficult to delicately manipulate by the practitioner. Further, as the handle portion of this retractor is straight, rather than angular, the hand which normally grips and guides the retractor will necessarily often obstruct the view of the user. Model No. A8540 of the same catalogue shows a retractor which has a long slim tapered handle which allows for easy manipulation by the user. However, as the handle portion is straight, the user's hand will still often block a direct view of the endotracheal tube. Further, the tube engaging portion of this retractor is formed generally in the shape of a common fork, with the tines curled around in order to make a scoop-like shape. For this reason, this retractor is extremely unsuitable for use in the blind technique, as the sharp tips of the tines are liable to engage and tear the tissue surrounding the area adjacent to the endotracheal tube.
The Scanlon-Morris Co. Brochure discloses at pages 2, 3 and 4 thereof a plurality of retractors for general use. The Model No. 86-54 retractor is disclosed as being for tracheal use. However, the design of this tracheal retractor is very similar to the previously mentioned Mueller retractor in that the endotracheal tube-engaging portion is provided with sharp tips, and is therefore of no utility in a blind intubation technique.
The Murray-Baumgartner Surgical Instrument Co. Catalogue (1934) again discloses a plurality of retractors for general surgical use. Of particular interest are the Model Nos. 2149-2152 which display a curved scoop-shaped retractor blade portion. However, it is noted that the handles of these retractors are thin, flat, and of an overall arcuate shape, and therefore have the same disabilities as regards delicate work as do the previously mentioned Mueller retractors.
The Charles Truax Greene & Co. Catalogue depicts a plurality of retractors for use in gynecology. FIG. 7233 of this Catalogue depicts a retractor which has a generally scoop-shaped end. However, the handle of this retractor does not allow the practitioner to grip and manipulate the device in a manner such that the practitioner's hand would not obstruct the view of an endotracheal tube.
The Journal of the American Medical Association, July 12, 1952, contains an article on pages 1018 and 1019 thereof which discusses the use of various types of generally S-shaped retractors formed of lucite. However, it is noted that none of the retractors disclosed in this article has a generally scoop-shaped blade attached to a thin elongated generally cylindrical gripping portion.
The most common retractor presently being used for tracheal intubation is the so-called Bearman hook. This device consists of a unitary length of wire formed with a hook at the end thereof. However, this hooked end is disadvantageous in that it has little utility in blind techniques due to the danger of damage to the surrounding tissue. Additionally, the Bearman hook has an inherent flexibility due to its thin wire-like construction, thereby causing difficulties in the lateral manipulation of the endotracheal tube.